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題名:醫院權屬別與醫療收費
書刊名:臺灣公共衛生雜誌
作者:張樂心鄭守夏楊銘欽江東亮
作者(外文):Chang, Le-hsinCheng, Shou-hsiaYang, Ming-chinChiang, Tung-liang
出版日期:2004
卷期:23:2
頁次:頁130-140
主題關鍵詞:醫院權屬別醫療費用自付費用住院天數支付制度OwnershipMedical expenseOut-of-pocketLength of stayPayment system
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(7) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:7
  • 共同引用共同引用:0
  • 點閱點閱:33
     目標:我國私人醫院比例高於美國三倍以上,不同權屬別醫院收取醫療費用是否不同,本研究提供臺灣實證資料。方法:以糖尿病、中風、剖腹產與闌尾切除四種常見疾病病人為研究對象,共4945名,分析不同權屬別醫院之醫療費用;包括醫院向病人收取之自付費用、向健保局申報之醫療費用,以及住院天數。並以同病再入院與術後傷口發炎率作為品質指標。結果:論病例計酬的剖腹產與闌尾切除病人,私人醫院的申報費用最低,但收取最高的自付費用與醫療總費用;論量計酬的糖尿病與中風患者,私人醫院的申報費用、自付費用與總費用皆顯著高於公立醫院。無論那種支付方式,公立醫院的平均住院天數皆較長。結論:私人醫院論病例計酬的申報費用低於公立醫院,論量計酬類則較高,其因應健保支付制度之費用策略可能較公立醫院明顯。公立醫院可能因公務預算補助等因素,收取最低的自付費用,但住院天數偏長。
     Objective: The proportion of private hospitals in Taiwan is 3 times higher than that in the United States. This study addresses the question as to whether private hospitals charge higher prices by providing empirical evidence from Taiwan. Method: There were 4945 patients with one of the common diagnoses/procedures of diabetes, stroke, Cesarean section, or appendicitis included in the analysis. The between-hospital comparisons were measured by patients?out-of-pocket payment, NHI claimed expenses, and patients?length of stay. We also adopted the readmission rate and post-operation infection rate as quality indicators for comparison. Results: Multiple regression models showed that private hospitals had the lowest level of claimed expenses, but higher out-of pocket and total expenses than their counterparts for procedures under the case payment method. Moreover, both their claimed reimbursements and out-of-pocket charges were both higher than that of public hospitals for diseases under the Fee-for-Service system. On average, public hospitals had the longest length of stay. Conclusion: Private hospitals seem more flexible in response to the NHI payment policy than public hospitals. Owing to the governmental subsidy, public hospitals charge lower out-of-pocket prices but have a longer length of stay.
期刊論文
1.Newhouse, Joseph P.(1970)。Toward a Theory of Nonprofit Institutions: An Economic Model of a Hospital。American Economic Review,60(1),64-74。  new window
2.Deyo, R. A.、Cherkin, D. C.、Ciol, M. A.(1992)。Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases。Journal of Clinical Epidemiology,45(6),613-619。  new window
3.Zwanziger, J.、Melnick, G.、Keeler, E. B.(1999)。The Changing Effects of Competition on Non-profit and For-profit Hospital Pricing Behavior。Journal of Health Economics,18,69-86。  new window
4.Charlson, M. E.、Pompei, P.、Ales, K. L.、MacKenzie, C. R.(1987)。A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation。Journal of Chronic Diseases,40(5),373-383。  new window
5.Hall, S.、McGuire, T. G.(1987)。Ownership and performance: the case of outpatient mental health clinics。Med Care,25,1179-1183。  new window
6.Hadley, J.、Zuckerman, S.、Iezzoni, L. I.(1996)。Financial Pressure and Competition: Changes in Hospital Efficiency and Cost-Shifting Behavior。Med Care,34,205-219。  new window
7.Freeh, H. E. III(1976)。The Property Rights Theory of the Firm: Empirical Results from a Natural Experiment。Journal of Political Economy,84,143-152。  new window
8.Silverman, E. M.、Skinner, J. S.、Fisher, E. S.(1999)。The association between for-profit hospital ownership and increased Medicare spending。New England Journal of Medicine,341,420-426。  new window
9.林恆慶、楊長興、陳楚杰、黃昱瞳(20030200)。醫院權屬別對其論病例計酬醫療費用影響之研究--以剖腹生產為例。慈濟醫學,15(1),55-61。  延伸查詢new window
10.Schlesinger, M.、Blumenthal, D.、Schlesinger, E.(1986)。Profits under Pressure: The Economic Performance of Investor-Owned and Nonprofit Health Maintenance Organizations。Med Care,24,615-627。  new window
11.Ettner, S. L.、Hermann, R. C.(2001)。The Role of Profit Status under Imperfect Information: Evidence from the Treatment Patterns of Elderly Medicare Beneficiaries Hospitalized for Psychiatric Diagnoses。Journal of Health Economics,20,23-49。  new window
12.Gray, B. H.、McNerney, W. J.(1986)。For-Profit Enterprise in Health Care: The Institute of Medicine Study。The New England Journal of Medicine,314,1523-1528。  new window
13.Hirth, R. A.、Chernew, M. E.、Orzol, S. M.(2000)。Ownership, Competition, and the Adoption of New Technologies and Cost-Saving Practices in a Fixed-Price Environment。Inquiry,37,282-294。  new window
14.Woolhandler, S.、Himmelstein, D. U.(1997)。Costs of Care and Administration of For-Profit and Other Hospitals in the United States。The New England Journal of Medicine,336,769-774。  new window
15.Zwanziger, J.、Melnick, G. A.、Bamezai, A.(2000)。Can Cost Shifting Continue in a Price Competitive Environment?。Health Econ,9(3),211-225。  new window
16.Glaser, W. A.(1984)。Juggling Multiple Payers: American Problems and Foreign Solutions。Inquiry,21,178-188。  new window
17.Dranove, D.、White, W. D.、Wu, L.(1993)。Segmentation in Local Hospital Markets。Med Care,31,52-64。  new window
18.Romano, P. S.、Roos, L. L.、Jollis, J. G.(1993)。Adopting a Clinical Comorbidity Index for Use with ICD-9-CM Administrative Data: Differing Perspectives。Journal of Clinical Epidemiology,46,1075-1079。  new window
19.Lin, H. C.、Chang, H. C.、Lee, S. C.、Yang, C. H.、Tung, Y. C.(2002)。Comparisons of LOS for Patients Under-Going a Transurethral Prostatectomy (TURP) by Hospital Level, Hospital Ownership and Hospital Location under the Case Payment System in Taiwan。N Taipei J Med,4,25-33。  new window
研究報告
1.行政院衛生署(2001)。中華民國八十九年衛生統計。臺北:行政院衛生署。  延伸查詢new window
2.張錦文(1993)。醫院成本實證研究。沒有紀錄。  延伸查詢new window
圖書
1.Robert, L. K.(1997)。Understanding Health Care Outcomes Research。Gaithersburg, MD:An Aspen Publication。  new window
2.Pauly, M. V.(1980)。Doctors and their workshops: economic models of physician behavior。Chicago, IL。  new window
3.Milgrom, Paul R.、Roberts, John(1992)。Economics, Organization and Management。Prentice-Hall International, Inc.。  new window
4.National Center for Health Statistics(2000)。Health, United States, 1999, with Health and Aging Chartbook。Health, United States, 1999, with Health and Aging Chartbook。Hyattsville, MD。  new window
5.Cutler, D. M.、Horwitz, J. R.(2000)。Converting Hospitals from Not-For-Profit to Profit Status: Why and What Effects?。The Changing Hospital Industry: Comparing Not-For-Profit and For-Profit Institutions。Chicago, IL。  new window
6.Anderson, G. A.、Lave, J. R.、Russe, G. M.、Neuman, P.(1989)。Producing Hospital Service。The Changing Hospital Environment。Baltimore, MD。  new window
 
 
 
 
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